Neurostimulation in generalized epilepsy: A systematic review and meta‐analysis

Haneef, Zulfi; Skrehot, Henry C.

doi:10.1111/epi.17524

“…Neuromodulation is also increasing surgical options for multifocal and generalized epilepsy. 30,31 Lower rates of evaluation among patients with generalized and indeterminate epilepsy may therefore represent an important care gap.…”

Section: Epilepsy Typementioning

confidence: 99%

Use of Recommended Neurodiagnostic Evaluation Among Patients With Drug-Resistant Epilepsy

Spotnitz,

Ekanayake,

Ostropolets

et al. 2024

JAMA Neurol

5

0

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ImportanceInterdisciplinary practice parameters recommend that patients with drug-resistant epilepsy (DRE) undergo comprehensive neurodiagnostic evaluation, including presurgical assessment. Reporting from specialized centers suggests long delays to referral and underuse of surgery; however, longitudinal data are limited to characterize neurodiagnostic evaluation among patients with DRE in more diverse US settings and populations.ObjectiveTo examine the rate and factors associated with neurodiagnostic studies and comprehensive evaluation among patients with DRE within 3 US cohorts.Design, Setting, and ParticipantsA retrospective cross-sectional study was conducted using the Observational Medical Outcomes Partnership Common Data Model including US multistate Medicaid data, commercial claims data, and Columbia University Medical Center (CUMC) electronic health record data. Patients meeting a validated computable phenotype algorithm for DRE between January 1, 2015, and April 1, 2020, were included. No eligible participants were excluded.ExposureDemographic and clinical variables were queried.Main Outcomes and MeasuresThe proportion of patients receiving a composite proxy for comprehensive neurodiagnostic evaluation, including (1) magnetic resonance or other advanced brain imaging, (2) video electroencephalography, and (3) neuropsychological evaluation within 2 years of meeting the inclusion criteria.ResultsA total of 33 542 patients with DRE were included in the Medicaid cohort, 22 496 in the commercial insurance cohort, and 2741 in the CUMC database. A total of 31 516 patients (53.6%) were women. The proportion of patients meeting the comprehensive evaluation main outcome in the Medicaid cohort was 4.5% (n = 1520); in the commercial insurance cohort, 8.0% (n = 1796); and in the CUMC cohort, 14.3% (n = 393). Video electroencephalography (24.9% Medicaid, 28.4% commercial, 63.2% CUMC) and magnetic resonance imaging of the brain (35.6% Medicaid, 43.4% commercial, 52.6% CUMC) were performed more regularly than neuropsychological evaluation (13.0% Medicaid, 16.6% commercial, 19.2% CUMC) or advanced imaging (3.2% Medicaid, 5.4% commercial, 13.1% CUMC). Factors independently associated with greater odds of evaluation across all 3 data sets included the number of inpatient and outpatient nonemergency epilepsy visits and focal rather than generalized epilepsy.Conclusions and RelevanceThe findings of this study suggest there is a gap in the use of diagnostic studies to evaluate patients with DRE. Care setting, insurance type, frequency of nonemergency visits, and epilepsy type are all associated with evaluation. A common data model can be used to measure adherence with best practices across a variety of observational data sources.

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“…To the Editors: Epilepsia has published two comparative effectiveness articles in the past 12 months that utilize systematic review and meta-analysis methodology to assess long-term seizure frequency reduction in focal and generalized onset epilepsies treated with neuromodulation. 1,2 The statistical assumptions in these analyses inadvertently bias the results.…”

Section: E T T E R Assumptions and Statistical Inferencementioning

confidence: 99%

“…Haneef and Skrehot extracted a mean seizure frequency reduction from Kawai et al of 43.4% (SD = 140.6%) for generalized seizures. 1 For all focal and generalized seizures, Touma et al extracted a mean seizure frequency reduction from Kawai et al of 27.2% (SD = 141.8%). 2 The wide SDs of seizure frequency change in these populations should prompt consideration of potential skewness, given seizure frequency reduction has a lower limit of 100%.…”

Section: E T T E R Assumptions and Statistical Inferencementioning

confidence: 99%

Assumptions and statistical inference

Nichol,

Verner,

Gordon

et al. 2023

Epilepsia

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“…In India, it is believed that over 10 million people suffer from epilepsy [ 4 ]. As per the World Health Organization (WHO), there are approximately 50 million persons with epilepsy globally, with 80% of them living in developing countries such as India [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Attenuation of Strychnine-Induced Epilepsy Employing Amaranthus viridis L. Leaves Extract in Experimental Rats

Bharadwaj

¹

,

Sharma

²

,

Singh

³

et al. 2023

Behavioural Neurology

2

0

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Objective. Epilepsy is one of the most prevalent neurological illnesses defined by periodic seizures with or without loss of consciousness caused by aberrant neural activity. There are many allopathic medications available for the treatment of epilepsy such as phenytoin (PHY), but the side effects are a major concern. Therefore, the present study involved the evaluation of the pharmacological significance of Amaranthus viridis L. extract (EAV) in the management of strychnine (STR)-induced epilepsy. Method. STR (3.5 mg/kg, i.p.) was injected into male rats 30 minutes after the pre-treatment of a standard drug (PHY: 20 mg/kg) and the two doses of EAV (EAV-200 and EAV-400 mg/kg, p.o.) to the respective groups to cause the convulsions. The anti-convulsant effect of EAV-200 and EAV-400 against STR-induced convulsion in rats was investigated in terms of convulsion onset, duration of convulsions, number of convulsions, and convulsion score. Furthermore, the mitochondrial function and integrity in the brain’s prefrontal cortex (PFC) were also estimated. Results. EAV-400 significantly increased the onset of convulsion from 61.67 ± 3.051 to 119.2 ± 2.738 and reduced the STR-induced duration of convulsions from 144.8 ± 3.582 to 69.17 ± 3.736 , number of convulsions from 4.000 ± 0.1592 to 1.533 ± 0.1542 , and convulsion score from 5.000 ± 0.3651 to 2.833 ± 0.3073 in rats. EAV-400 significantly attenuated the STR-induced decrease in the mitochondrial function and integrity of the rat PFC. In rats, EAV-400 significantly accelerated the onset of convulsions while decreasing the STR-induced duration, frequency, and score. Conclusion. Based on investigational findings, EAV-400 could be inferred to be a possible anti-epileptic option for the treatment of epilepsy of this plan in preclinical research.

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Neurostimulation in generalized epilepsy: A systematic review and meta‐analysis

Cited by 25 publications

References 48 publications

Use of Recommended Neurodiagnostic Evaluation Among Patients With Drug-Resistant Epilepsy

Use of Recommended Neurodiagnostic Evaluation Among Patients With Drug-Resistant Epilepsy

Assumptions and statistical inference

Attenuation of Strychnine-Induced Epilepsy Employing Amaranthus viridis L. Leaves Extract in Experimental Rats

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